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Putting
PEOPLE first
The world has not yet won the battle against Ebola. Until Ebola is eliminated, getting to
zero should remain the highest priority.
In Sierra Leone and Liberia, thousands of local Priorities that Oxfam has heard from
people have taken part in campaigns to spread the local communities
message about how Ebola can be controlled, and
Oxfam heard passionate calls for:
millions have taken vital practical steps to prevent
infection. When the last case of Ebola is eliminated, The continuation of strong community engagement
it will not only be because of medical treatment to support effective treatment, case finding,
and action by governments and the international contact tracing and safe burials.
community, but because communities have been at
Urgent resources such as soap and chlorine,
the heart of the response.
transport to allow health workers to reach remote
Before Ebola struck West Africa, Liberia and Sierra areas and ambulances to take people who are sick
Leone were among the poorest countries in the quickly to treatment centres.
world now they are even poorer. The challenge of
A stronger health care system with more clinics,
recovery is enormous and communities must be at
more equipment and more health workers. This
the heart of it.
requires greater investment, including in sufficient
Oxfam has listened to women and men in Liberia and training and payment for health workers.
Sierra Leone to hear their priorities for the immediate
The gains made in this response including
response, the recovery and beyond. Underpinning all
thousands of new community health workers and
of those priorities, listed on the right, was the need
increased community understanding surrounding
to continue listening to communities as the struggle
hygiene to be retained and strengthened.
against Ebola continues and recovery plans are
formed and implemented. A boost to livelihoods and the economy to help
tackle the increased poverty and debt following the
Oxfam publishes this report in the strong belief that
Ebola outbreak. This could be through cash grants
it is for the people of Liberia and Sierra Leone to
and new sources of credit, allowing people to begin
say what their priorities are for both the immediate
trading and restart their businesses again.
response and long term recovery. However, it is for all
of us to demand that helping all affected countries Children to return to school, which will only be
remains a global priority and that we stand by them possible for many families with support from the
through recovery once the Ebola headlines are over. government or international donors to pay fees.
The fear and threat of new Ebola cases is still very Ebola is still here. And it can still kill.
real, particularly in Sierra Leone where the number James Bundoo, Clara Town, Liberia
of cases appears to plateau in February 2015 at
7080 per week. Hundreds of families are currently in
quarantine, struggling to get the food, water, health
care and sanitation that they need.
For those who have been infected with Ebola
and survived, many have been welcomed and
supported, but many others still suffer stigma and
discrimination.
with my husband. He decided to leave.1
Midwife Amie Subah, Monrovia, Liberia.
Our main priority is this: to see an
end to Ebola.
Community Health Committee member, Thunder Hill,
Sierra Leone
No one should be complacent because this deadly disease is still around.
A focus group participant in Thunder Hill community, Sierra Leone
As Oxfam listened to women and men from The structures that have been put in
local communities in Liberia and Sierra place are very effective. My concern is that
Leone, we heard an overwhelming demand they are supported in the future. Actively
that the local and volunteer structures finding cases has located new Ebola
developed to fight Ebola should not be sufferers, but also people at home dying of
forgotten. curable diseases; so when we find them,
we can get them the care they need.
We heard many calls for continued vigilance both
People wont die unnecessarily anymore.
amongst communities, their governments and
Eric Patten, secretary of the Ebola Task Force.
international donors. We also heard calls for urgent
practical support, such as the provision of soap,
chlorine and buckets, as well as better transport to
allow community health workers to reach remote
areas and ambulances to take sick people swiftly for
treatment.
Above: Community Chief Alie Balansama Marah, Sengbeh in Eric Patten,secretary of the Ebola Task Force,
Koinadugu, Sierra Leone. Photo: Michelle Curran/Oxfam New Kru Town, Liberia. Photo: Renata Rendn/Oxfam
The government should be supporting
social mobilization all the time.
Ward Committee Secretary, Gbendenbu, Sierra Leone
people respond to our message.
Bernadette Samura, a volunteer community health worker.
Bernadette Samura, a volunteer community health worker, going house-to-house with vital Ebola health advice in
Pamaronkoh, Sierra Leone
towards
recovery
Ebola is more than a war. It has destroyed our culture and our society.
Community health committee supervisor, Mayenkineh, Sierra Leone
The challenge presented by the Ebola outbreak extends beyond getting to zero to
helping affected countries recover and as one person in Thunder Hill, Sierra Leone put
it back on the road to development.
sleep on.
Fatu Conteh, John Thorpe community, Sierra Leone.
Times were hard before Ebola. Now Above, main picture: Mattresses being burned in Thigbonoh,
they are worse. Sierra Leone, where almost half of its residents were
Nura Sloboh, New Kru Town, Liberia quarantined. Photo: Abbie Trayler-Smith/Oxfam
Before Ebola people had so many Now its Ebola, we have no serious
things a market, petty trading but development.
now everything is limited. I have three Mary Kamara, a councillor in Pamaronkoh, Sierra Leone.
Photo: Michelle Curran/Oxfam
children. After Ebola, my main purpose
is for them to go back to school. But
because of Ebola, Sierra Leone is at the
bottom of development.
Mary Sesay, a public health volunteer in the John Thorpe
community, western Sierra Leone. Photo: Michelle Curran/Oxfam
will be better.
Stephen Seckor with one of his nieces, Monrovia, Liberia. Photo: Abbie Trayler-Smith/Oxfam
BUILDING A
RESILIENT HEALTH
SERVICE
One woman was having her baby at home. It died because no one would help
her. They were too afraid. This happened to many women. When Ebola came,
the children died. There was nowhere to go, no hospital. We need a hospital
here. We need a health system.
Elizabeth Cuffy, Fundaye community, New Kru Town, Liberia. Photo: Renata Rendn/Oxfam
More than 9,500 people have died in the Ebola outbreak in West Africa, but the impact
has gone far beyond those directly infected and their families.
Already scarce health resources have been Ebola is not a normal disease. This
primarily focussed on Ebola treatment and fear kind of thing has never happened
of infection has meant that people with other, before. Doctors were dying, nurses were
sometimes equally life-threatening health needs,
dying, cleaners were dying. People
havent been able to access health services.
didnt know what to do in the beginning,
In listening to local communities, Oxfam also
until we were trained. Training upon
repeatedly heard stories of the impact on womens
maternal health.
training has helped us to adapt. But in
the future, all medical practitioners
When in hospital, pregnant women should be trained in Ebola.
cannot be touched because of Ebola. Alice Stevens, government hospital matron, Jui, Sierra Leone.
women are dying and suffering.
Bernadette Samura, a volunteer health worker in
Pamaronkoh, Sierra Leone
more nurses.
Bernadette Samura, a volunteer health worker in Pamaronkoh,
challenge for both countries is huge. Liberia and
Sierra Leone Sierra Leones health services have never been
strong, although before the Ebola epidemic they
Listening to communities in both Liberia and Sierra were improving, including in vital areas like the
Leone, Oxfam repeatedly heard calls for proper rates of mortality among mothers and children. But
health systems. Community health workers in both countries health services were overwhelmed
Gbendenbu, Sierra Leone, told us that the country during the Ebola outbreak. Their health workers
needs improved community health centres to already few died alongside so many others. In one
prepare for future outbreaks and emergencies, clinic in Logan Town, Liberia, 6 out of 15 staff died
more health workers and equipment and training, within 10 days.
and also safe water and sanitation, including in
The challenge of building a resilient health care
health centres and schools.
system goes far beyond numbers and training.
More health workers will not make a big enough
sector is not improved. have access to quality health services for free; this
George Caulae, Fundaye community, New Kru Town, Liberia
requires major public investment.
Yes, theres a clinic. But when you get
there, you wont get any treatment you
need. They say its free. But when you
get there, they ask you to pay a
reasonable amount. It says free
outside. But its not.
James Bundoo, Clara Town, Liberia
One of Sierra Leones Ebola health workers, Masiaka Community Care Centre, near Port Loko. Photo: Abbie Trayler-Smith/Oxfam
Rebuilding
shattered LIVES
To restart our lives, we need support. I was a businessman in West Point, but when
West Point was quarantined, I could not get to my business. There were soldiers with guns.
I couldnt enter. Before the quarantine, I had $325 saved, but I ate 90 per cent of that. My
business collapsed. I have three children. Two more depend on me too. I am still in debt.
George Caulae, Fundaye community, New Kru Town, Liberia. Photo: Renata Rendn/Oxfam
The far-reaching impact of the Ebola epidemic has crippled the economies of Liberia,
Sierra Leone and Guinea.
and unemployment is soaring.
Community health coordinator, Thunder Hill, Sierra Leone
of families had seen their incomes fall, the average I want the international community
decrease being 39 per cent.2 to assist traders, especially
businesswomen. Women have suffered
Agriculture, fishing and petty trading even more from Ebola because
are my communitys livelihood. Ebola so many have lost their husbands, lost
has put a stop to them all.
their elder sons who were helping.
Elizabeth Cuffy, Fundaye community, New Kru Town, Liberia
Kadiatu Turay, who returned to Thunder Hill, Sierra Leone from
the United States in March 2014 to be close to her family.
Photo: Michelle Curran/Oxfam
We need a credit union for women, to
help them work. We need loans. Before
Ebola, women used to work more; they
sold food and other things in the
market. Now they need loans and credit.
They are really suffering.
Elizabeth Cuffy, Fundaye community, New Kru Town, Liberia
since I recovered. and left farmers calling for help in the form of seed
Mamani Kamara, (above) an Ebola survivor who used to make a
supplies, equipment and credit.
living selling rubber in Pamaronkoh, Sierra Leone.
Photo: Michelle Curran/Oxfam
The biggest change I want for Sierra
Mamani Kamara (above) is not alone. Many women Leone is to have job opportunities for
in West Africa make their living through informal everyone. We have lost a lot of lives. The
trade, with 70 per cent of traders crossing borders biggest change I want for Sierra Leone
being women.3 Informal trade has been heavily is to have job opportunities for
affected by the Ebola outbreak due to restrictions
everyone. We have lost a lot of lives ...
on the movement of people and limitation of
no business has been going on.
market opening hours. As a result, women have
Everything has gone backwards.
been particularly affected and many have lost their
Samuel Kambo, (below) is a community health worker in the
livelihoods. John Thorpe community in western Sierra Leone.
Photo: Michelle Curran/Oxfam
Making
schools safe
and free for all
Ebola stopped education.
Francis Foray Dalakroma, head of the Youth Council in Koinadugu, Sierra Leone. Photo: Michelle Curran/Oxfam
After the struggle against Ebola itself, the number one issue individuals and communities
expressed was the unaffordable cost of education, worsened by the fact that many people
have lost their jobs and livelihoods.
A lack of adequate funding means that despite
laws enshrining free primary education schools
demand informal fees, making it very difficult for
many families to send their children to school.
In Sierra Leone, many people echoed this call
from a woman in Gbendenbu that the government
should help parents by paying school fees, since
their income is down. In Liberia, many told Oxfam of
schools planning to increase fees as they reopen.
have no money and no support. Before I need help to get an education now.
Ebola, I was working as a mechanic I miss school. At school we were
fixing cars, machines. I tried to get my learning and now miss it. We are just
job back, but they said that they could playing now.
Alusine Kamara Taylor, 10 years old, who survived Ebola but lost
not take me back because of the Ebola. his mother, grandmother, brother and sister, with his aunt,
I dont know when I will be able to send Aminata Kamee, in Thunder Hill, Sierra Leone.
my children back to school. My hopes for Photo: Michelle Curran/Oxfam
should make school free.
Nintos Roberts, an Ebola survivor in central New Kru Town, Liberia
A clear programme for the rehabilitation of schools
is necessary, including improvement of facilities
and continued awareness of good hygiene
practices. Parents want desperately to send their
girls and boys back to school to get the quality
education that they need, but there are fears that
schools may not be safe. The universal drive to give
children a brighter future has been intensified for
many people as they have seen the damaging
consequences of school closures, including a
rise in teenage pregnancies. From listening to
communities, Oxfam heard various reasons for this,
The international community, NGOs including girls being driven to prostitution after
and government must come together to their parents had died.
repair schools and construct schools
and put things in place that we have
lost school furniture, benches,
blackboards, books. And as schools
reopen we need health centres too, so
anyone sick can reach help.
Fatmata Kamara, a teacher at the Baptist Community Primary
School, Meyenkeneh, Sierra Leone. Photo: Michelle Curran/Oxfam
no facilities to wash hands4 and a survey of 351 I dont feel 100 per cent safe or good
schools found that, on average, 113 girls shared about sending my children to school.
each female latrine and 118 boys each male latrine.5 Many schools are not equipped with
proper latrines and hand pumps for
washing. There is no sewage system.
We need the government to step in and
make sure that schools are safe. But
even when the country is Ebola free,
parents wont be able to send children
back to school because they cant
afford it.
Jacob Myers, central New Kru Town, Liberia
oxfams response
to ebola
Oxfams response to Ebola currently focuses on supporting communities to prevent
the spread of infection, as well as providing medical facilities with water, sanitation,
cleaning equipment and protective clothing.
With a budget of $35m to cover initiatives in Sierra In both Sierra Leone and Liberia, Oxfam supplies
Leone, Liberia, Mali, Gambia, Guinea Bissau and water, sanitation and hygiene materials to Ebola
Senegal, Oxfam aims to help over 3.2 million people treatment centres and community care centres.
at risk of catching the disease. To date, we have In other countries including Guinea Bissau,
supported more than 1.1 million people in Liberia Gambia and Senegal Oxfam and its partners have
and Sierra Leone. In Liberia, Oxfam currently works launched programmes to disseminate educational
with community health workers to carry out active messages surrounding Ebola through posters, SMS
case finding. This involves seeking out individuals and door-to-door outreach.
who are showing Ebola symptoms and ensuring
that they are isolated immediately and referred
for treatment. In Sierra Leone, we are supporting
community health committees to identify and
address barriers to controlling the spread of Ebola.
Focus group of community health workers in Thunder Hill, For further information on the issues raised in this
Sierra Leone, February 2015. Photo: Michelle Curran/Oxfam paper please e-mail:
advocacy@oxfaminternational.org
Published by Oxfam GB for Oxfam International
under ISBN 978-1-78077-825-9 in March 2015.
Oxfam GB, Oxfam House, John Smith Drive, Cowley,
Oxford, OX4 2JY, UK.
Front cover: Hassanatou (not her real name), 17, survived Ebola
but her six month old baby girl Khadijatu died. She was then
quarantined at her family home in the Kontoloh community in
Jalloh Lane, Rokupa, Sierra Leone.
Photo: Abbie Trayler-Smith/Oxfam
LAST WORDS
Kadiata Sesay, 18, a student, in Grafton, Sierra Leone. Her family live inside the quarantine but she has to stay outside.
Photo: Abbie Trayler-Smith
To people outside West Africa, we I want to ask the international
want to thank you. But we still need community to help my country develop
help from you too. We need good health after Ebola because our economy
facilities. We need jobs. We need has collapsed.
money and business so we can send A councillor in Kabala, Sierra Leone
our children to school.
A focus group of women in Clara Town, Liberia
My hopes? Its my prayer that the
international community will not stop
more Ebola now. We are tired.
Fatmata Kamara, a teacher at the Baptist Community Primary future.
School, Meyenkeneh, Sierra Leone Jacob Myers, central New Kru Town, Liberia